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ESA 4 - Head and Neck > Osteology of Skull and Cervical Spine > Flashcards

Osteology of Skull and Cervical Spine Flashcards

1
Q

What are the categories of cervical vertebrae?

A
  • Typical
  • Atypical
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2
Q

What does wether a cervical vertebrae is typical or atypical depend on?

A

Their osteological features

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3
Q

What are the atypical cervical vertebrae?

A

C1, C2, and C7

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4
Q

What is C1 known as?

A

Atlas

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5
Q

What shape is C1?

A

Ring shaped

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6
Q

What is the function of the atlas?

A

Supports the skull at the atlanto-occipital joint

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7
Q

What does the atlas articulate with inferiorly?

A

The second cervical vertebrae

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8
Q

What is C2 known as?

A

Axis

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9
Q

How does the strength of the axis compare to other cervical vertebrae?

A

It is the strongest of all cervical vertebrae

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10
Q

Why is the axis need to be the strongest cervical vertebrae?

A

Because C1, carrying the skull, rotates on it

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11
Q

What feature does C2 have?

A

Odontoid process (the dens)

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12
Q

Where does the odotoid process project?

A

Superiorly from its body

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13
Q

How is the odontoid process held in position?

A

By strong transverse ligament of atlas

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14
Q

What is the function of the transverse ligament of the atlas?

A

Prevents horizontal displacement of the atlas, thus stabilises the atlanto-axial joint

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15
Q

What is the bony skeleton of the neck formed by?

A

The 7 cervical vertebrae

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16
Q

Where do the cervical vertebae lie?

A

Between the skull and the thorax

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17
Q

What is found between each vertebrae?

A

An intervertebral disc

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18
Q

What is the exception to there being an intervertebral disc between vertebrae?

A

There is no vertebral disc between C1/2

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19
Q

Why is there no intervertebral disc between C1/2?

A

Because C1 has no vertebral body

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20
Q

How do the cervical vertebrae differ in function to other vertebrae in the body functionally?

A
  • They bear less weight than vertebrae in other regions of the body
  • Convey a much greater degree of mobility
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21
Q

How do cervical vertebrae differ from other vertebrae in the body structurally?

A
  • Much smaller
  • Have a foramen in each of their transverse processes
  • Vertebral foramen is much larger
  • Articular surfaces are more horizontally orientated
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22
Q

Why do cervical vertebrae have a foramen in each of their transverse processes?

A

Transmit vertebral arteries on their way to supply the back of the brain

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23
Q

Which cervical vertebrae doesn’t have transverse foramen?

A

C7

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24
Q

Why is the vertebral foramen of cervical vertebrae much larger than other vertebrae in the body?

A

Accommodate much thicker cervical spinal cord

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25
Q

What happens to the vertebral foramen the more caudal it goes?

A

It gets smaller

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26
Q

Why does the vertebral foramen get smaller as it runs more caudally?

A

Because the spinal cord it transmits gets thinner, as more and more nerves leave the spinal cord to innervate various structures

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27
Q

What is the result of the articular surfaces of cervical vertebrae being more horizontally orientated than in other vertebrae?

A

They can dislocate or ‘slip off’ at much less force than is required for them to fracture

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28
Q

What is the skull?

A

The collective term referring to the complete skeleton of the head

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29
Q

What does the skull include?

A
  • Cranium
  • Mandible
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30
Q

What can the cranium be further subdivided into?

A
  • Neurocranium
  • Viscerocranium
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31
Q

What is the neurocranium?

A

The bones forming a protective box around the brain

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32
Q

What is the viscerocranium?

A

Bones forming facial skeleton

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33
Q

What does the neurocranium consist of?

A
  • Calvaria
  • Cranial floor
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34
Q

What is the calvaria?

A

The skull, or cranial, cap

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35
Q

What is the lower limit of the calvaria?

A

It has no lower limit to it as such

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36
Q

What do the bones of the calvaria consist of?

A

Two layers of bones, seperated by a layer of spongy bone

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37
Q

What is the layer of spongy bone in the calvaria known as?

A

Diploe

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38
Q

What is true of the innermost layer of the calvaria in adults?

A

It is particularly brittle

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39
Q

What is the purpose of the trilaminar arrangement of bone in the calvaria?

A

It conveys protective stength, without adding significant weight

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40
Q

What is the thinnest part of the calvaria?

A

The pterion

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41
Q

Where does the pterion lie?

A

On the lateral aspect of the skull

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42
Q

What is between the large, flat bones forming the calvaria?

A

Sutures

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43
Q

What are sutures?

A

Serrated, immobile joints of strong fibrous tissue

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44
Q

What are the names of the sutures?

A
  • Coronal
  • Sagittal
  • Lamboid
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45
Q

What is the clinical relevance of sutures?

A
  • Interlocking nature of these joints makes it very different or bones forming the joint to dislocate
  • As we age, suture lines begin to ossify
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46
Q

What is the cranial floor divided into?

A

Three areas, or fossa

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47
Q

What are the areas of the cranial floor?

A
  • Anterior
  • Middle
  • Posterior
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48
Q

What is found in the cranial floor?

A

A number of foramina (holes)

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49
Q

What is the function of the holes in the cranial floor?

A

Allow for passage of anatomical structures between extra- and intra-cranial compartments

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50
Q

What structures pass through the foramen in the cranial floor?

A
  • Cranial nerves
  • Blood vessels
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51
Q

What is the clinical relevance of the large number of foramina in the cranial floor?

A

Make the cranial floor vulnerable to fracture

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52
Q

When can the vertebral floor fracture?

A

When significant force is transmitted through the skull base

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53
Q

What is the viscerocranium formed by?

A
  • Bones enclosing the orbits
  • Nasal cavity
  • Oral cavity
  • Paranasal sinuses
  • Maxillae
  • Mandible
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54
Q

What is the maxillae?

A

The upper jaw

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55
Q

What is the mandible?

A

The lower jaw

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56
Q

What does the jaw house?

A

The teeth

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57
Q

What are the main features of the anterior aspect of the skull?

A
  • Frontal bones
  • Zygomatic bones
  • Orbits
  • Nasal region
  • Maxillae
  • Mandible
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58
Q

What do the frontal bones form?

A

Skeleton of forehead

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59
Q

What does the frontal bone articulate with?

A
  • Nasal bones
  • Zygomatic bones
  • Lacrimal bones
  • Ethmoid bones
  • Sphenoid bones
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60
Q

What do the frontal bones form?

A
  • Roof of orbit
  • Part of floor of cranial cavity
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61
Q

What are the zygomatic bones?

A

Cheek bones

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62
Q

Where do the zygomatic bones lie?

A

On the inferolateral sides of orbits

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63
Q

What do the zygomatic bones articulate with?

A
  • Frontal bone
  • Sphenoidal bone
  • Temporal bone
  • Maxillae
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64
Q

What does the maxillae constitute?

A

The greater part of the upper facial skeleton

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65
Q

What is the maxillae fixed to?

A

Cranial base

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66
Q

Why is the mandible moveable?

A

Because it articulates with the cranial base at the temporomandibular joint

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67
Q

Why is the temporomandibular joint special?

A

It is the only moveable joint of the skull

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68
Q

What is found just above the orbital margin?

A

Supraciliary arch

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69
Q

What is the supraciliary arch?

A

A sharp bony ridge

70
Q

Will slight dislocation of the cervical vertebrae damage the spinal cord?

A

It may or may not

71
Q

Why may slight dislocation of the cervical vertebrae not damage the spinal cord?

A

Due to large vertebral canal in cervical region

72
Q

What may significant dislocation of the cervical vertebrae cause?

A

Serious injuries to the spinal cord

73
Q

What serious injuries to the spinal cord can be caused by significant dislocation of the cervical vertebrae?

A
  • Partial paralysis
  • Complete paralysis
  • Death
74
Q

What are the most common sites of cervical spine injuries?

A
  • C1/2
  • C6
  • C7
75
Q

Where do most severe (often fatal) spinal injuries occur?

A

In the upper part of the spine (C1-4)

76
Q

What does damage to the upper part of the spine lead to?

A
  • Quadriplegia
  • Cessation of respiratory movements
77
Q

When may a hyperflexion of the cervical spine injury occur?

A

During head on collision

78
Q

What do hyperflexion injuries of cervical spine tend to involve?

A

Lower part of cervical spine

79
Q

What can hyperflexion injuries of the cervical spine lead to?

A
  • Crush factors of the vertebral body
  • Rupture of supraspinous ligament
  • Rupture of lower cervical intervertebral discs
80
Q

Give an example of a crush fracture of the cervical spine?

A

Cervical wedge fracture

81
Q

Is a cervical wedge fracture stable?

A

May be, if just one vertebra is involved

82
Q

How will a cervical wedge fracture present on x-ray?

A

Loss of height of vertebral body

83
Q

What are crush fractures of the vertebral body associated with?

A

Spinal degenerative disease

84
Q

Give an example of a spinal degenerative disease?

A

Osteoporosis

85
Q

What is the effect of the rupture of the supraspinous ligament?

A

Makes bony spine unstable

86
Q

What cervical intervertebral discs can rupture?

A
  • C5/6
  • C6/7
87
Q

What complication can rupture of the lower cervical spinal discs cause?

A

May cause compression of spinal nerve roots C6 and C7

88
Q

What are hyperextension injuries of the neck associated with?

A

Rear-end vehile collision

89
Q

What do hyperextension injuries of the neck most commonly affect?

A

Upper cervical spine

90
Q

What can hyperextension injuries of the neck result in?

A
  • Vertebral fracture
  • Disc prolapse
  • Cervical spinous process or odontoid process fracture
  • Tearing of anterior longitudinal ligament
  • Kinking of posterior longitudinal ligament
91
Q

Where may hyperextension injuries of the neck cause kinking of the posterior longitudinal ligament?

A

In the degenerative spine

92
Q

What is the protective function of car seat head rests?

A

They act to minimise the range of hyperextension that can occur at the neck

93
Q

What is a Hangmans Fracture?

A

A type of injury that can occur caused by hyperextension of the neck

94
Q

When may a Hangmans Fracture occur?

A

During judicial hanging, not suicidal hanging

95
Q

What is the cause of death in suicidal hanging?

A

Asphyxiation

96
Q

What happens in a Hangmans Fracture?

A

Bilateral fracture of posterior arch of C2, and disruption of C2-3 junction

97
Q

Is a hangmans fracture stable?

A

No

98
Q

What is the result of a Hangmans Fracture being unstable?

A

There is a risk of C2 displacement and spinal cord damage

99
Q

What needs to be done when someone presents with a Hangmans Fracture?

A

MRA

100
Q

Give an example of how an axial load injury through the head and neck may occur?

A

Falling onto head from height

101
Q

What may an axial load injury through the head and neck cause?

A

Jeffersons fracture

102
Q

What is a Jeffersons fracture?

A

A burst fracture of C1

103
Q

What happens in a Jeffersons fracture?

A

Combination of anterior and posterior arch fractures

104
Q

Is a Jeffersons fracture unstable?

A

It can be

105
Q

What may be neccessary if a Jeffersons fracture is unstable?

A

External fixation

106
Q

Why must patients presenting with a suspected neck injury be managed carefully?

A

Avoid (further) damage to the cervical spinal cord

107
Q

Do all neck injuries or cervical fractures cause damage to the spinal cord?

A

No

108
Q

What should happen to any patient with significant mechanism for neck injury?

A

They should have full in-line spinal immobilisation

109
Q

Why should all patients with significant mechanism for spinal injury have full in-line spinal immobilisation?

A

Due to the potentially catastrophic neurological consequences should spinal injury occur

110
Q

What does full in-line spinal immobilisation include?

A

Immobilisation of the cervical spine with;

  • Appropriately sized semi-rigid collar
  • Head blocks
  • Tape

And rest of patients spine immoblised on a spinal board

111
Q

When is immobilisation no longer required following a spinal injury?

A

When the cervical spine has been ‘cleared’

112
Q

When can the cervical spine be ‘cleared’ after injury?

A

When the patient is determined to be at minimal risk for spinal injury

113
Q

What does the clearing of a C-spine follow?

A

Thorough clinical examination

114
Q

What is the clearing of a C-spine based on?

A

Specific criteria, e.g. Canadian C-spine rules

115
Q

What should be done if any doubt remains about possibility of spinal injury, or risk to spine, and the C-spine cannot be cleared confidently by clinical examination?

A

Radiological examinations undertaken

116
Q

What radiological examinations can be undetaken to clear a C-spine?

A
  • Plain radiography, involving 3 views of the cervical spine
  • CT
117
Q

When is an x-ray used as the radiological examination to clear C-spine?

A

In paediatrics

118
Q

Why are x-rays used to clear the C-spine in paediatrics?

A

Because don’t want radiation around structures of the neck, e.g. the thymus

119
Q

What would happen if a fracture or other injury was identified on radiological imaging of the C-spine?

A

Further management would depend on the type of injury found

120
Q

What are the facet joints of the vertebral arches (zygopophyseal joints) close to?

A

Intervertebral foramina

121
Q

What emerges through the intervertebral foramina?

A

Spinal nerves

122
Q

What happens if the zygapophyseal joints are affected by osteoarthritis?

A

Intervertebral foramen can narrow

123
Q

What can age related changes in intervertebral discs cause?

A

Cause the discs to bulge, narrowing the intervertebral foramen

124
Q

What can narrowing of the intervertebral foramen cause?

A

Compression of the spinal nerve exiting at that vertebral level

125
Q

Give two pathologies resulting from narrowing of the intervertebral foramen?

A
  • Cervical spondylotic myelopathy
  • Cervical spondylotic radiculopathy
126
Q

What happens in cervical spondylotic myelopathy?

A

Spinal cord compression

127
Q

What does cervical spondylotic myelopathy lead to?

A
  • Loss of function
  • Often loss of fine motor skills in upper limbs
128
Q

What happens in cervical spondylotic radiuclopathy?

A

Nerve root impingement

129
Q

What does cervical spondylotic radiculopathy lead to?

A

Dermatomal arm pain, with or without mild weakness and sensory loss

130
Q

What can osteoarthritis of the C-spine lead to?

A

Cervical spondylosis

131
Q

In laymans terms, what is cervical spondylosis?

A

‘Wear-and-tear’ of C-spine vertebrae

132
Q

Who does cervical spondylosis affect?

A

Older population

133
Q

How common is cervical spondylosis?

A

Very common

134
Q

What are the features of cervical spondylosis?

A
  • Osteophytes
  • Facet joint hypertrophy
  • Disc herniation
  • Disc space narrowing
  • Sclerosis of end plates
135
Q

What are osteopytes?

A

Bony spurs

136
Q

What may severe blows to the skull result in?

A
  • Local depression and splintering of bone
  • Series of linear fractures radiating away from the initial point of injury
137
Q

What severe trauma to the skull may result in fractures?

A

Impact injuries or blows

138
Q

What complications can arise from skull fractures?

A

Can damage underlying brain and/or blood vessels

139
Q

What does bleeding into the cranial cavity cause?

A

Haematoma

140
Q

What are the types of intracranial haematoma?

A
  • Epidural
  • Extradural
  • Subdural
141
Q

Where does an extradural haematoma occur?

A

Between skull periosteum and outermost meningeal layer

142
Q

What is the outermost meningeal layer?

A

Dura mater

143
Q

What happens in an extradural haematoma?

A

It bleeds into the skull at high pressure, which can press on the brain, causing abnormal neurology

144
Q

Wha is an extradural haematoma associated with?

A

Trauma and skull fracture

145
Q

What is it important to do when a patient presents with a head injury?

A
  • Examine head and any wounds thoroughly
  • Undertake neurological assessment
146
Q

What should be determined in a neurological assessment?

A

If there is evidence, or risk of, brain injury

147
Q

What should be done when there is clinical suspicion of intracranial haemorrhage?

A
  • CT imaging of head
  • Consideration to possibility of C-spine injury
148
Q

What is a basilar skull fracture?

A

Fracture through cranial floor

149
Q

When can a basilar skull fracture occur?

A

If significant force is transmitted through the vertebral column

150
Q

Why can a basilar skull fracture occur if significant force is transmitted through vertebral column?

A

Because base of skull is connected to vertebral column

151
Q

How does a basilar skull fracture present?

A
  • Battle’s sign
  • ‘Raccoon’ eyes
  • Haemotympanum
  • Meningeal tears
  • Cranial nerve palsies
152
Q

What is Battle’s sign?

A

Bruising over mastoid process

153
Q

What is ‘Raccoon’ eyes?

A

Bruising around both eyes

154
Q

What is haemotympanum?

A

Blood behind ear drum

155
Q

What results from meningeal tears?

A

Bleeding and/or CSF leakage from;

  • Ear
  • Nose
156
Q

What is is called when CSF leaks from the ears?

A

CSF otorrhea

157
Q

What is it called when CSF leaks from the nose?

A

CSF rhinorrhea

158
Q

Why may a basilar skull fracture lead to cranial nerve palsies?

A

As cranial nerves run along base of skull in many cases

159
Q

What is there a risk of in basilar skull fractures?

A
  • Meningtis
  • Need for neurosurgical intervention
160
Q

How common are basilar skull fractures?

A

Uncommon, less than 5% of skull fractures

161
Q

What does a fracture at the pterion risk?

A

Injuring the middle meningeal artery (anterior branch)

162
Q

Why does a fracture at the pterion risk damaging the middle mengingeal artery?

A

As it lies immediately beneath the bone

163
Q

What will bleeding from the anterior branch of the middle meningeal artery cause?

A

Extradural haematoma

164
Q

What happens in an extradural haematoma from the anterior branch of the middle meningeal artery?

A

Blood accumulates between the periosteal layer of dura mater and the bone, exerting pressure on underlying brain

165
Q

How are injuries to the facial skeleton caused?

A
  • Road traffic collisions
  • Fights
  • Falls
166
Q

What do the most common facial fractures involve?

A
  • Nose
  • Zygomatic bone
  • Mandible
167
Q

Why are fractures of the nasal bone common?

A

Because of the prominence of the nose

168
Q

What does a hard blow to the lower jaw often result in?

A

Fracture of the neck of the mandible and its body

169
Q

What may fracture of the mandible be associated with?

A

Dislocation of the temporomandibular joint

170
Q

What is required to fracture the maxillary and frontal bones?

A

Significant force

ESA 4 - Head and Neck (30 decks)

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